Individual
CHRISTINE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
16566 NEWHOPE ST, FOUNTAIN VALLEY, CA 92708-2403
(714) 663-6554
Mailing address
22411 RIDGEBROOK, MISSION VIEJO, CA 92692-4531
(678) 294-8298
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110002301
NATA BOC
—
Enumeration date
07/17/2017
Last updated
07/17/2017
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